Procedure Manual: COVID-19 Resources

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This resource guides you through procedures unique to the adult progressive and critical care environment, including those performed by advanced practice nurses, in a step-by-step format.

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Endotracheal Intubation (Assist)

Author: Cindy Goodrich

Endotracheal intubation is performed to establish and maintain a patent airway, facilitate oxygenation and ventilation, reduce the risk of aspiration and assist with the clearance of secretions.

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Endotracheal Tube Care and Oral Care Practices for Ventilated and Non-ventilated Patients

Authors: Kathleen Vollman, Mary Lou Sole and Barbara Quinn

Endotracheal tube (ETT) management and oral care are performed to prevent buccal, oropharyngeal and tracheal trauma from the tube and cuff; to provide oral hygiene; to promote ventilation; and to decrease the risk of ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia.

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Suctioning: Endotracheal or Tracheostomy Tube

Author: Maureen A. Seckel

Endotracheal or tracheostomy tube suctioning is performed to maintain the patency of the artificial airway and to improve gas exchange, decrease airway resistance and reduce infection risk by removing secretions from the trachea and main-stem bronchi. Suctioning also may be performed to obtain samples of tracheal secretions for laboratory analysis.

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Pronation Therapy

Authors: Kathleen Vollman, Sharon Dickinson and Jan Powers

The prone position is used in an attempt to improve oxygenation and reduce ventilator-induced lung injury in patients with acute respiratory distress syndrome (ARDS).

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Invasive Mechanical Ventilation (Through an Artificial Airway): Volume and Pressure Modes

Author: John Gallagher

Initiation and maintenance of positive-pressure ventilation through an artificial airway are accomplished to maintain or improve oxygenation and ventilation and to provide respiratory muscle rest.

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Noninvasive Positive Pressure Ventilation: Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BiPAP)

Author: Susan K. Frazier

Noninvasive positive pressure ventilation is used to prevent airway obstruction during sleep, to maintain or improve ventilation and/or oxygenation, and to provide respiratory muscle rest in patients in whom invasive mechanical ventilation is not possible, acceptable or desired.

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Peripheral Nerve Stimulators

Author: Nathan W. Howard

Peripheral nerve stimulators (PNSs) are used in association with the administration of neuromuscular-blocking medication agents to assess nerve-impulse transmission at the neuromuscular junction of selection skeletal muscles.

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Arterial Catheter Insertion (Assist), Care and Removal

Authors: Hillary Crumlett and Alex Johnson

Arterial catheters are used for continuous monitoring of blood pressure, assessment of cardiovascular effects of vasoactive drugs and frequent arterial blood gas and laboratory sampling. In addition, arterial catheters provide access to blood samples that support the diagnostics related to oxygen, carbon dioxide and bicarbonate levels (oxygenation, ventilation and acid-base status).

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Central Venous/Right Atrial Pressure Monitoring

Author: Reba McVay

Central venous/right atrial pressure monitoring provides information about the patient’s intravascular volume status and right-ventricular preload. Central venous pressure (CVP) or right atrial pressure (RAP) allows for evaluation of right-sided heart hemodynamics and evaluation of patient response to therapy. CVP and RAP are used interchangeably.

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Single-Pressure and Multiple-Pressure Transducer Systems

Author: Reba McVay

Single-pressure and multiple-pressure transducer systems provide a catheter-to-monitor interface, so that intravascular and intracardiac pressures can be measured. The transducer detects a biophysical event and converts it to an electronic signal.

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Calculating Doses, Flow Rates and Administration of Continuous Intravenous Infusions

Authors: Shelley Burcat and Maribeth Kelly

Calculation of doses and flow rates and administration of continuous intravenous (IV) infusions are performed to ensure accurate delivery of medications administered via the IV route. Many of the medications delivered via continuous IV infusion have potent effects and narrow margins of safety; therefore, accuracy in calculation and administration of these agents is imperative.

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